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penetrating cardiac injury

Joe Nemeth, Mr joe.nemeth at mcgill.ca
Sun Dec 20 13:50:50 GMT 2009


First off...Merry Christmas and Happy Holidays to all!

To the question:

2 nights ago....

20 y.o. stab wound to box...
On arrival BP 80/-....while 2 C/T are going in PC view shows the obvious...
C/T's put out nothing...BP 50/-
Clam shell done...identified obvious Rt. V. defect, achieved "finger hemostasis"...
BP 130/-...Surgeon arrives, pledgeted sutures placed...
Goes to OR...does very poorly after...
Actually sustained an interventricular septal wound as well with resulting Lt. to Rt. shunt...obviously not recognized earlier...

Questions: 
How many of your institutions have perfusionist stand-by/?in-house for urgent bypass in these cases?
Who among the trauma surgeons is trained to feel comfortable placing someone on bypass a opposed to calling in a cardiac surgeon?
Who has experience using adenosine to simplify suturing/stapling?

jn






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